Wright Charles B, Ambati Jayakrishna
Physiology and Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, KY, 40506, USA.
Handb Exp Pharmacol. 2017;242:321-336. doi: 10.1007/164_2016_36.
Age-related macular degeneration (AMD), the most common form of irreversible blindness in the industrially developed world, can present years before a patient begins to lose vision. For most of these patients, AMD never progresses past its early stages to the advanced forms that are principally responsible for the vast majority of vision loss. Advanced AMD can manifest as either an advanced avascular form known as geographic atrophy (GA) marked by regional retinal pigment epithelium (RPE) cell death or as an advanced form known as neovascular AMD marked by the intrusion of fragile new blood vessels into the normally avascular retina. Physicians have several therapeutic interventions available to combat neovascular AMD, but GA has no approved effective therapies as of yet. In this chapter, we will discuss the current strategies for limiting dry AMD in patients. We will also discuss previous attempts at pharmacological intervention that were tested in a clinical setting and consider reasons why these putative therapeutics did not perform successfully in large-scale trials. Despite the number of unsuccessful past trials, new pharmacological interventions may succeed. These future therapies may aid millions of AMD patients worldwide.
年龄相关性黄斑变性（AMD）是工业化发达国家中最常见的不可逆失明形式，可在患者开始视力丧失前数年出现。对于大多数此类患者而言，AMD从未进展至晚期，而晚期病变是导致绝大多数视力丧失的主要原因。晚期AMD可表现为一种晚期无血管形式，即地图样萎缩（GA），其特征为局部视网膜色素上皮（RPE）细胞死亡；或表现为一种晚期形式，即新生血管性AMD，其特征为脆弱的新血管侵入正常无血管的视网膜。医生有多种治疗手段可用于对抗新生血管性AMD，但截至目前，GA尚无获批的有效疗法。在本章中，我们将讨论目前在患者中限制干性AMD的策略。我们还将讨论以往在临床环境中进行测试的药物干预尝试，并思考这些假定疗法在大规模试验中未取得成功的原因。尽管过去有许多试验未成功，但新的药物干预可能会取得成功。这些未来的疗法可能会帮助全球数百万AMD患者。
